Preventing Cryptosporidiosis:A Guide for Persons with HIV and AIDS

What is
cryptosporidiosis?

Cryptosporidiosis
(krip-toe-spo-rid-e-o-sis),
often called "crypto," is a disease caused by a one-celled
parasite, Cryptosporidium parvum, also known as "crypto."
Crypto, which cannot be seen without a very powerful microscope, is so
small that over 10,000 of them would fit on the period at the end of this
sentence.

What are the symptoms of crypto
?

Although sometimes
persons infected with crypto do not get sick, when they do get sick they
can have watery diarrhea, stomach cramps, an upset stomach, or a slight
fever. In some cases, persons infected with crypto can have severe
diarrhea and lose weight. The first symptoms of crypto may appear 2 to 10
days after a person becomes infected.

How does crypto affect you if
your immune system is severely weakened ?

In people with AIDS and
in others whose immune system is weakened, crypto can be serious,
long-lasting and sometimes fatal. If your CD4+ cell count is below 200,
crypto is more likely to cause diarrhea and other symptoms for a long
time. If your CD4+ count is above 200, your illness may not last more than
1 to 3 weeks or slightly longer. However, you could still carry the
infection, which means that the crypto parasites are living in your
intestines, but are not causing illness. As a carrier of crypto, you could
infect other people. If your CD4+ count later drops below 200, your
symptoms may reappear.

How is crypto spread?

You can get crypto by
putting anything in your mouth that has touched the stool, (bowel
movement) of a person or animal with crypto. You can also get crypto by
touching your mouth before washing your hands after touching the stool of
infected persons, or touching the stool of infected animals, or touching
soil or objects contaminated with stool. Drinking contaminated water or
eating contaminated food can also give you crypto. Cryptosporidiosis is not
spread by contact with blood.

Can crypto be treated ?

Yes, but no drug has
been found yet to cure it. Some drugs, such as paromomycin, may reduce the
symptoms of crypto and new drugs are being tested. If you think you have
crypto, or if you just have diarrhea, talk with your health care provider
about testing and treatment. Diarrhea can cause dehydration. You should
drink plenty of fluids to prevent dehydration. Oral rehydration powders
and sports-ade drinks can also help prevent dehydration.

How can I protect myself from
crypto?

You can reduce your
risk of getting crypto. The more steps you take, the less likely you are
to get crypto. These actions will also help protect you against other
diseases.

1. Wash your hands.

Washing your hands
often with soap and water is probably the single most important step you
can take to prevent crypto and other illnesses. Always wash your hands
before eating and preparing food. Wash your hands well after touching
children in diapers; after touching clothing, bedding, toilets, or bed
pans soiled by someone who has diarrhea; after gardening; any time you
touch pets or other animals; and after touching anything that might have
had contact with even the smallest amounts of human or animal stool,
including dirt in your garden and other places. Even if you wear gloves
when you do these activities you should still wash well when you finish.
Children should be supervised by adults to make sure they wash their
hands well.

2. Practice safer
sex.

Infected people may
have crypto on their skin in the anal and genital areas, including the
thighs and buttocks. However, since you cannot tell if someone has
crypto, you may want to take these precautions with any sex partner:

"Rimming"
(kissing or licking the anus) is so likely to spread infection that you
should avoid it, even if you and your partner wash well before.

If you touch a farm
animal, particularly a calf, lamb, or other young animal, or visit a
farm where animals are raised, wash your hands well with soap and water
before preparing food or putting anything in your mouth. Do not touch
the stool of any animal. After you visit a farm or other area
with animals, have someone who is not HIV infected clean your shoes, or
wear disposable gloves if you clean them yourself. Wash your hands after
taking off the gloves.

4. Avoid touching
the stool of pets.

Most pets are safe to
own. However, someone who is not HIV infected should clean their litter
boxes or cages, and dispose of the stool. If you must clean up after a
pet, use disposable gloves. Wash your hands afterwards. The risk of
getting crypto is greatest from pets that are less than 6 months old,
animals that have diarrhea, and stray animals. Older animals can also
have crypto, but they are less likely to have it than younger animals.
If you get a puppy or kitten that is less than 6 months old, have the
animal tested for crypto before bringing it home. If any pet gets
diarrhea, have it tested for crypto.

5. Be careful when
swimming in lakes, rivers, or pools, and when using hot tubs.

When swimming in
lakes, rivers, or pools, and when using hot tubs, avoid swallowing
water. Several outbreaks of crypto have been traced to swallowing
contaminated water while swimming. Crypto is not killed by the amount of
chlorine normally used in swimming pools and water parks. Crypto also
can remain alive in salt water for several days, so swimming in polluted
ocean water may also be unsafe.

6. Wash and/or cook
your food.

Fresh vegetables and
fruits may be contaminated with crypto. Therefore, wash well all
vegetables or fruit you will eat uncooked. If you take extra steps to
make your water safe (see below for ways to do so), use this safe water
to wash your fruits and vegetables. When you can, peel fruit that you
will eat raw, after washing it. Do not eat or drink unpasteurized milk
or dairy products. Cooking kills crypto. Therefore, cooked food and
heat-processed foods are probably safe if, after cooking or processing,
they are not handled by someone infected with crypto, or exposed to
possibly contaminated water.

7. Drink safe water.

Do not drink water
directly from lakes, rivers, streams, or springs. Because you cannot be
sure if your tap water contains crypto, you may wish to avoid drinking
tap water, including water or ice from a refrigerator ice-maker, which
are made with tap water. Because public water quality and treatment vary
throughout the United States, always check with the local health
department and water utility to see if they have issued any special
notices about the use of tap water by HIV infected persons. You may also
wish to take some additional measures: boiling your water, filtering
your water with certain home filters, or drinking certain types of
bottled water. Processed carbonated (bubbly) drinks in cans or bottles
are probably safe, but drinks made at a fountain might not be because
they are made with tap water. If you choose to take these extra
measures, use them all the time, not just at home. If the public health
department advises boiling the water, do not drink tap water unless you
boil it. You could also use one of the bottled waters described below.

A. Boiling
water: Boiling is the best extra measure to ensure that your
water is free of crypto and other germs. Heating water at a rolling boil
for 1 minute kills crypto, according to CDC* and EPA** scientists. After
the boiled water cools, put it in a clean bottle or pitcher with a lid
and store it in the refrigerator. Use the water for drinking, cooking or
making ice. Water bottles and ice trays should be cleaned with soap and
water before use. Do not touch the inside of them after cleaning. If you
can, clean water bottles and ice trays yourself.

B. Filtering
tap water: Not all available home water filters remove crypto.
All filters that have the words "reverse osmosis" on the label
protect against crypto. Some other types also work, but not all filters
that are supposed to remove objects 1 micron or larger from water are
the same. Look for the words "absolute 1 micron." Some "1
micron" and most "nominal 1 micron" filters will not work
against crypto. Also look for the words "Standard 53" and the
words "cyst reduction" or "cyst removal" for an
NSF-tested filter that works against crypto.

To find out if a
particular filter removes crypto, contact NSF International (3475 Plymouth
Road, P.O. Box 130140, Ann Arbor, MI 48113-0140, tel: 1-800-673-8010, fax:
1-313-769-0109), an independent testing group. Ask NSF for a list of
"Standard 53 Cyst Filters." Check the model number on the filter
you intend to buy to make sure it is exactly the same as the number
on the NSF list. Look for the NSF trademark on filters, but be aware that
NSF tests filters for many different things. Because NSF testing is
expensive, many filters that may work against crypto have not been tested.
Reverse osmosis filters work against crypto whether they have been tested
by NSF or not. Many other filters not tested by NSF also work if they have
an absolute pore size of 1 micron or smaller.

If you choose to buy a
filter, look for this information on the label:

Filters
designed to remove crypto(any
of the four messages below on a package label indicate that the
filter should be able to remove crypto)

Reverse osmosis
(with or without NSF testing)

Absolute
pore size of 1 micron or smaller
(with or without NSF
testing)

Tested and certified by
NSF Standard 53 for cyst removal

Tested and certified by
NSF Standard 53 for cyst reduction

Filters
labeled only with these words may not
be designed to remove crypto

Filters collect germs from your
water, so someone who is not HIV infected should change the filter
cartridges for you; if you do it yourself, wear gloves and wash your hands
afterwards. Filters may not remove crypto as well as boiling does because
even good brands of filters may sometimes have manufacturing flaws that
allow small numbers of crypto to get past the filter. Also, poor filter
maintenance or failure to replace filter cartridges as recommended by the
manufacturer can cause your filter to fail.

C. Bottled
water: If you drink bottled water, read the label and look for
this information:

Water
so labeled has been processed by method effective against crypto

Water
so labeled may not have been processed by method effective against
crypto

Reverse osmosis treated

Filtered

Distilled

Micro-filtered

Filtered through an absolute
1 micron or smaller filter

Carbon-filtered

"One micron
absolute"

Particle-filtered

Multimedia-filtered

Ozonated

Ozone-treated

Ultraviolet light-treated

Activated carbon-treated

Carbon dioxide-treated

Ion exchange-treated

Deionized

Purified

Chlorinated

Bottled water labels reading
"well water," "artesian well water," "spring
water," or "mineral water" do not guarantee that the water
does not contain crypto. However, water that comes from protected well or
protected spring water sources is less likely to contain crypto than
bottled water or tap water from less protected sources, such as rivers and
lakes. Any bottled water (no matter what the source) that has been treated
by one or more of the methods listed in the top part of the water filters
table is considered safe.

D. Home
distillers: You can remove crypto and other germs from your
water with a home distiller. If you use one, you need to carefully store
your water as recommended for storing boiled water.

E. Other drinks:
Soft drinks and other beverages may or may not contain crypto. You need
to know how they were prepared to know if they might contain crypto.

If you drink prepared
drinks, look for drinks prepared to remove crypto:

Information
on Prepared Drinks

Crypto
killed or removed in preparation

Crypto
may not be killed or removed in preparation

Canned or bottled soda,
seltzer, and fruit drinks

Fountain drinks

Steaming hot (175 degrees
F or hotter) tea or coffee

Fruit drinks you mix with
tap water from frozen concentrate

Pasteurized drinks

Iced tea or coffee

Juices made from fresh
fruit can also be contaminated with crypto. Several people became ill
after drinking apple cider made from apples contaminated with crypto. You
may wish to avoid unpasteurized juices or fresh juices if you do not know
how they were prepared.

8. Take extra care
when traveling.

If you travel to
developing nations, you may be at a greater risk for crypto because of
poorer water treatment and food sanitation. Warnings about food, drinks,
and swimming are even more important when visiting developing countries.
Avoid foods and drinks, in particular raw fruits and vegetables, tap
water, or ice made from tap water, unpasteurized milk or dairy products,
and items purchased from street vendors. These items may be contaminated
with crypto. Steaming-hot foods, fruits you peel yourself, bottled and
canned processed drinks, and hot coffee or tea are probably safe. Talk
with your health care provider about other guidelines for travel abroad.

For more information on crypto,
call the CDC National HIV and AIDS Hotline at 1-800-342-AIDS.

This information was
prepared by the inter-agency Working Group on Waterborne Cryptosporidiosis,
which includes representatives from the Centers for Disease Control and
Prevention, Environmental Protection Agency, Food and Drug Administration,
U.S. Department of Agriculture, National Association of People With AIDS,
AIDS Coalition to Unleash Power, and representatives of state and local
health departments and water utilities.

*CDC--Centers for
Disease Control and Prevention

**EPA--Environmental
Protection Agency

This fact sheet is for
information only and is not meant to be used for self-diagnosis or as a
substitute for consultation with a health care provider. If you have any
questions about the disease described above or think that you may have a
parasitic infection, consult a health care provider.